Question 1 of 14
Have had a fever in the past two weeks.
Question 2 of 14
Have had a cough in the past two weeks?
Question 3 of 14
Have you experienced unexplained shortness of breath in the past two weeks?
Question 4 of 14
Have traveled in the past 4 weeks?
Question 5 of 14
Have you been in contact with someone traveling from a known location of an outbreak.
Question 6 of 14
Have you been in close contact with someone confirmed with coronavirus
Question 7 of 14
Do you work in a healthcare facility that has treated a case of coronavirus.
Question 8 of 14
Are you at risk of having a weakened immune system.
Question 9 of 14
Do you have any of the following illnesses?
Question 10 of 14
Do you have any other health conditions?
Question 11 of 14
Are you taking any regular medications
Question 12 of 14
Do you have any allergies
Question 13 of 14
Is these any further information you would like to provide
Question 14 of 14
Would you like to have a video or telephone consultation?